San Francisco architect Lee Hammack says he and his wife, JoEllen Brothers, are “cradle Democrats.” They have donated to the liberal group Organizing for America and worked the phone banks a year ago for President Obama’s re-election.

Since 1995, Hammack and Brothers have received their health coverage from Kaiser Permanente, where Brothers worked until 2009 as a dietitian and diabetes educator. “We’ve both been in very good health all of our lives – exercise, don’t smoke, drink lightly, healthy weight, no health issues, and so on,” Hammack told me.

The couple — Lee, 60, and JoEllen, 59 — have been paying $550 a month for their health coverage — a plan that offers solid coverage, not one of the skimpy plans Obama has criticized. But recently, Kaiser informed them the plan would be canceled at the end of the year because it did not meet the requirements of the Affordable Care Act. The couple would need to find another one. The cost would be around double what they pay now, but the benefits would be worse.

“From all of the sob stories I’ve heard and read, ours is the most extreme,” Lee told me in an email last week.

I’ve been skeptical about media stories featuring those who claimed they would be worse off because their insurance policies were being canceled on account of the ACA. In many cases, it turns out, the consumers could have found cheaper coverage through the new health insurance marketplaces, or their plans weren’t very good to begin with. Some didn’t know they could qualify for subsidies that would lower their insurance premiums.

So I tried to find flaws in what Hammack told me. I couldn’t find any.

They do not qualify for premium subsidies because they make more than four times the federal poverty level, though Hammack says not by much.

Hammack recalled his reaction when he and his wife received a letters from Kaiser in September informing him their coverage was being canceled. “I work downstairs and my wife had a clear look of shock on her face,” he said. “Our first reaction was clearly there’s got to be some mistake. This was before the exchanges opened up. We quickly calmed down. We were confident that this would all be straightened out. But it wasn’t.”

I asked Hammack to send me details of his current plan. It carried a $4,000 deductible per person, a $40 copay for doctor visits, a $150 emergency room visit fee and 30 percent coinsurance for hospital stays after the deductible. The out-of-pocket maximum was $5,600.

This plan was ending, Kaiser’s letters told them, because it did not meet the requirements of the Affordable Care Act. “Everything is taken care of,” the letters said. “There’s nothing you need to do.”

The letters said the couple would be enrolled in new Kaiser plans that would cost nearly $1,300 a month for the two of them (more than $15,000 a year).

And for that higher amount, what would they get? A higher deductible ($4,500), a higher out-of-pocket maximum ($6,350), higher hospital costs (40 percent of the cost) and possibly higher costs for doctor visits and drugs.

When they shopped around and looked for a different plan on California's new health insurance marketplace, Covered California, the cheapest one was $975, with hefty deductibles and copays.

In a speech in Boston last week, President Obama said those receiving cancellation letters didn’t have good insurance. “There are a number of Americans — fewer than 5 percent of Americans — who've got cut-rate plans that don’t offer real financial protection in the event of a serious illness or an accident,” he said.

“Remember, before the Affordable Care Act, these bad-apple insurers had free rein every single year to limit the care that you received, or use minor preexisting conditions to jack up your premiums or bill you into bankruptcy. So a lot of people thought they were buying coverage, and it turned out not to be so good.”

What is going on here? Kaiser isn’t a “bad apple” insurer and this plan wasn’t “cut rate.” It seems like this is a lose-lose for the Hammacks (and a friend featured in a report last month by the public radio station KQED.)

I called Kaiser Permanente and spoke to spokesman Chris Stenrud, who used to work for the U.S. Department of Health and Human Services. He told me that this was indeed a good plan. Patients in the plan, known as 40/4000, were remarkably healthy, had low medical costs and had not seen their premiums increase in years. “Our actuaries still aren’t entirely sure why that was,” he said.

While many other insurance companies offered skimpier benefits, Stenrud said, “our plans historically have been comprehensive.”

Kaiser has canceled about 160,000 policies in California, and about one third of people were in plans like Hammack’s, Stenrud said. About 30,000 to 35,000 were in his specific plan.

“In a few cases, we are able to find coverage for them that is less expensive, but in most cases, we’re not because, in sort of pure economic terms, they are people who benefited from the current system ... Now that the market rules are changing, there will be different people who benefit and different people who don’t.”

“There’s an aspect of market disruption here that I think was not clear to people,” Stenrud acknowledged. “In many respects it has been theory rather than practice for the first three years of the law; folks are seeing the breadth of change that we’re talking about here.”

That’s little comfort to Hammack. He’s written to California’s senators and his representative, House Minority Leader Nancy Pelosi, D-Calif., asking for help.

“We believe that the Act is good for health care, the economy, & the future of our nation. However, ACA options for middle income individuals ages 59 & 60 are unaffordable. We’re learning that many others are similarly affected. In that spirit we ask that you fix this, for all of our sakes,” he and Brothers wrote.

Consumer advocate Anthony Wright said it’s important to remember the way the insurance market worked before the act was passed, when insurers could deny coverage based on pre-existing conditions. “It’s impossible to know what the world would have looked like for these folks in the absence of the law,” said Wright, executive director of the group Health Access.

“We certainly had an individual market, especially in California which was the Wild Wild West, where there was huge price increases, cancellations, a range of other practices.

“That doesn't mean that there were certain people who lucked out in the old system, who wound up in a group with a relatively healthy risk mix and thus lower premiums,” he added. “The question is: Is health insurance something where people get a rate based on the luck of the draw or do we have something where we have some standards where people who live in the same community, of the same age, with the same benefit package are treated equally?”

Wright said discussions should focus on how to provide consumers like Hammack with assistance if they barely miss qualifying for subsidies.

So what is Hammack going to do? If his income were to fall below four times the federal poverty level, or about $62,000 for a family of two, he would qualify for subsidies that could lower his premium cost to as low as zero. If he makes even one dollar more, he gets nothing.

That’s what he’s leaning toward — lowering his salary or shifting more money toward a retirement account and applying for a subsidy.

“We’re not changing our views because of this situation, but it hurt to hear Obama saying, just the other day, that if our plan has been dropped it’s because it wasn’t any good, and our costs would go up only slightly,” he said. “We’re gratified that the press is on the case, but frustrated that the stewards of the ACA don’t seem to have heard.”

“Some didn’t know they could qualify for subsidies that would lower their insurance premiums.”

Yes, that’s true, but it’s hardly fair to call that a “debunking” as the linked article did, after explaining that the lady in question qualified for “massive federal subsidies.” After all, some people with slightly higher incomes but with the same plan would not qualify for subsidies. (The cliff for singles is in the $45-$50k range, higher for families.) Not everyone is subsidized.

Thus, the existence of subsidies mitigating the problem for one anecdote (but the math otherwise checking out, as appears to be the case in that linked article) is also strong evidence that other people *would* be strongly negatively affected, since they don’t get the subsidies.

Gary, the Affordable Care Act rules specify that non-grandfathered plans must be terminated. Not “modified” - terminated. Further, the state of California specifically required all non-grandfathered plans to be terminated. This language was contained in the contract that insurance companies had to sign in order to continue to offer plans through Covered California (the state exchange.) Under the law, Kaiser did not have the option to tweak these policies. They were forced to cancel them.

I’m really sick of those trying to make excuses. When you make everyone pay for things they will never need, and then set up these minimum requirements as if it’s society’s responsibility to pay for the choices of individuals, this is what happens.

The Tea Party tried to warn you. But, the liberals put the Democratic Party FIRST, not the country.

There are ways this could have been avoided. For example, hold Obama accountable for being a liar since 2008.

It’s absurd really. So someone who makes a dollar more past the subsidization point essentially makes less than someone who does makes a dollar less? If they are going to subsidize, it should be weighted, not flat.

Obama supporters like these should be happy because this is exactly what they supported and voted for. In fact, they were assured time after time by Obama himself that they would be able to keep their current insurance if they wanted to. I guess Obama figured that his lies wouldn’t be exposed until after he got re-elected when it wouldn’t matter anymore.

It’s hard to feel sorry for people who got exactly what they voted for. And I LOVE the writer, who’s saying, essentially, all those OTHER stories of people getting dumped and finding coverage that was worse for more money weren’t true. THIS one is because I know these people. Do you think this couple is alone? Millions are in the same boat.

Liberals want to share the wealth as long as it doesn’t come directly out of there pockets. How can you really be surprised, he told everyone including Joe the Plumber that we needed to share the wealth. Maybe Dems. will pay a little more close attention next time.

This is definitely sad news, but on the other hand we as a country are now all paying for their voting decisions. People need to unfortunately feel pain to see what damage the left will do. Conservatives can only warn people to an extent…

This story sounds eerily similar to what happened to my family. Basically, if you earn over the subsidy level, your insurance prices will double. I was fortunate that my carrier BlueCross allowed me to re-enroll as of December 1 for another year (prior to the ACA deadline). With a re-enrollment in my same “lousy” plan I only got a 5% increase in premium. If this option was not available, I would be scrambling like millions of others. I am hopeful that this law implodes prior to Dec 1, 2014 when I will be forced into an ACA plan. My options prior to then:

1. Accept the fact that costs will double and cut back on everything else.
2. Find a job with insurance (currently self-employed)
3. Not realistic for me, but may be an option for others…Get divorced and live with your family. My “ex”-wife and three kids would get a 100% subsidy. One payer rather than 5 saves about $10K a year.
4. Shut down my business…fire myself and my wife, collect double unemployment, get free health care, food stamps, and get great college financial aid packages for the kids while leading a stress free. life.

What about the woman in California (likely Obama supporter) with stage 4 cancer who had her coverage and access to her doctor dropped by ObamaCare.

She wrote an opEd in the Wall Street Journal, and the Obama folks went on the attack. They accused United Health Care of arbitrarily dropping her because of it’s small footprint in California, therefore couldn’t afford to keep her plan.

The Obama minions didn’t mention that UHC is the largest provider in the nation AND according the agreement UHC had with the Obama Administration, was forced to drop her.

You were “skeptical about media stories featuring those who claimed they would be worse”. Really guy? Wake up.

I’m 31 self employed, my old plan isn’t “great” like you mentioned but I was paying $130 a month now the new plan I’m being offered also isn’t “great” (its silver colored tho yay!) and it’s nearly $300 a month.

It is important to mention something that is not getting much press. The rates this year will be much lower than the next few years. Too few people who are healthy are signing up for the ACA plans. In order to cover the costs of people with pre-existing conditions, rates are projected to go up as much as 50% more in the next year. The press is not covering this as they did not cover the huge rate increases and increases to deductibles that was known months ago.

I don’t really understand what they thought Obamacare would be. Did they think it would mean everyone got free healthcare except for the ‘evil’ rich? They thought the 1% would pay for everyone, not understanding that when Obama said he wanted to spread the wealth around, he meant them specifically. The middle class. Under socialism, everyone is brought down the the lowest common denominator. See, they’re already learning they have to earn less money so they can receive welfare to survive in this brave new world. Subsidies are welfare. Subsidies are welfare. And anything the government gives to you it can take away.

Two things: One, I love that they write to Pelosi for help, like she’s Landrew from the old Star Trek episode; and Two, this guy Chris Wright shows that the socialists feel free to finally take off the mask and reveal that they have nothing but contempt for people who make their own economic decisions.

The only thing worse than an incorrectly used word is an incorrectly used buzz phrase. “Lose-lose” refers to a situation in which both sides of a transaction come out damaged; it is the child of “win-win” which was coined as a sales pitch to suggest that something would benefit every party at no cost (must have been a liberal politician crafted THAT phrase).

I live in Canada. In our ‘Universal Healthcare System’, the government decides how much money hospitals receive to treat patients. Budgets are set and people are putting on waiting lists so that budgets are not overdone. Per Canadian, we are charged $4000 for our healthcare system. So, a family of four has to pay $16,000 in taxes to access or ‘free’ healthcare system.

My Aunt, while suffering from headaches for many years, kept asking her doctor for an MRI/CAT scan so that she could have the testing necessary to find out why her headaches were happening and why regular medication was not effective in getting rid of them. Because of equipment and personnel shortages (artificially imposed by the government budgets), her doctor did not send her for such testing. Unless something is obvious during an exam, many PCP will not schedule certain tests, as we dont have enough machines and workers to diagnose everyone that needs such diagnosis.

Anyways, after 6 years, my Aunt finally was able to convince a PCP to get her an appointment with the hospital and have an MRI done on her upper body. After her scan, she was informed that she had brain, throat and lung cancer. They operated on her, but it was too late. She died within 3 months of her surgery.

That is what government healthcare and government imposed budgets will do to America. You guys will be put on waiting lists, be refused care, and many of you will suffer or die because of a legally imposed denial of care.

My mom’s boyfriend came down with an infection of his spinal cord that needed immediate attention. When he went to his local hospital, they didnt have the equipment to diagnose him and he was sent to another hospital 2 hours away, for treatment. He was given steroids to reduce the swelling of his spine, but the doctors told him that each minute he was without the steroidal injections, he was suffering irreversible damage to his nerves. He got out of the hospital and hasnt been able to walk as he once did, since the infection.

Again, because of government imposed shortages, the first hospital he went to couldnt treat him properly. And in the end, he suffered more permanent damage to his spine.

However, one ironic thing about my province - Ontario - is that dogs and cats can carry private health insurance and access private care, even though human being in my province, cant. So, essentially, animals are given more freedom over their health than the people who own them. That’s social values, for ya!

The only thing that surprises me is that the Hammacks blindly supported ACA and ignored the warnings from opponents that virtually EVERYONE who already had private insurance would lose it (cancelled policy) or have dramatically increased premiums. Basic arithmetic tells even the casual observer that it must result in higher cost because previously uninsured people with high-risk high-cost are being added to the pool, the law requires the insurers to cover them. The people who had and could afford insurance, like the Hammacks, pay for that.

What is coming next is the shortage of doctors and treatment facilities to handle the crush of newly ‘insured’ people who are having their health insurance subsidized through taxpayers (like the Hammacks). This is basic economics 101: Demand has been drastically increased (new healthcare consumers who could/would not pay out of pocket before) while the supply (doctors & clinics) has remained unchanged which means that ther WILL BE SHORTAGES.

Why are people so stubborn about party loyalty that they ignore aritmetic and basic economics? Pat your party affiliation on your tombstone if you like but the establishment of both the Democrats and Republicans are happy to grow government until it collapses from it’s own weight. Possibly within this decade if the ACA debacle is any indication.

“Under the Affordable Care Act, premiums can only vary based on the following factors: age, family composition, geographic area, and tobacco use.

Age:
Premium rates cannot vary by age for enrollees under the age of 21.
Premium rates cannot vary by age for enrollees age 64 or older.
Premium rates can vary by age for enrollees between the ages of 21 and 63, on each birthday, until a person turns 63.

Older enrollees cannot be charged more than 3 times the amount that younger enrollees are charged.

Family Composition:
Premiums may vary based on family composition.
Geographic Area:

Geographic rating areas are established by each state. If a state does not choose its geographic rating areas, it will default to rating areas established by the Department of Health and Human Services (HHS).
Tobacco Use:

Tobacco users cannot be charged more than 1.5 times the rate of non-users. “

Plus there is the 80/20 underwriting rule.

So in the end in each area that the “contract” doesn’t meet the requirements you must change the policy. To change the policy means a new policy and your old contract is voided. To do otherwise would be an administrative nightmare and heck…it all could cause an insurance company to not meet the 80/20 rule.

I can tell you for a fact that in my individual policy (I am a man) that you WILL NOT find coverage for Maternity and newborn care or Pediatric Services.

Nope the blame lies squarely in the lap of the Federal government. It is not as simple as the simple people think. Should all students be taught to read contracts? Yes so that they understand legislation such as the ACA.

Brothers and Hammack, and anyone else is in the individual insurance market, should definitely look into getting a plan that is compliant with a Health Savings Account. This will allow them to put up to $4300 apiece (tax deductible) into an HSA investment account. Unlike the FSA that a lot of people are familiar with, HSA savings can be rolled over into the next calendar year, and contents of the account can be invested to appreciate tax free. This HSA will have two basic effects that they will find desirable. First, it can be used to pay for a variety of medical expenses, including expenses that their health plan won’t pay for because of their health plan deductible. Second, it would reduce their taxable income by up to $8600 dollars each year. Unlikely regular medical expenses, expenses paid for by an HSA escape the newly raised 10% threshold that is part of the 2014 tax laws.

Grandfather, shmandfather. What country are we living in?!! If I have an insurance plan that I’m happy with, I should be able to keep it! And even after Obamacare passed; if I want to purchase a specific policy, I should have the freedom to do so! I’m sick of the notion that incompetent government bureaucrats should dictate what is or isn’t good for me!!

As for the heroes of this story; sorry, I have no mercy! Try giving Hillary a call; she’s you’re next version of hope and change.

If you are healthy, you will pay more, relative to your actual risk.
I don’t understand why libs didn’t get this.
The wh’s suggestion that a majority of Americans would benefit from obamacare is laughable. A majority of Americans are healthy, while a modest number are sick.

In this case, I can’t understand their shock. This is the govt they wanted. Obama told joe the plumber he was going to “spread the wealth around”...time to pony up.

Cutting off the Tax Credits at only 400% of the Poverty level is a real trap for many middle class Baby Boomers under 65.

One issue not investigated is this: I thought the ACA says no one pays more than 9.5% of income for a policy. However, those over about 55 making over the cut off are getting trapped in this gap. A single person in CA misses 500 to 600 per month tax credits and until the make over 100K per year they will pay to high a percentage of income according to the ACA rule.

I read someplace but can’t confirm that those in the Middle Class income gap are eligible for the Catastrophic Plans like the under 30 set. Can a reporter talk to CoveredCA and confirm?

Also since the Exchanges are run and regulated by each state this couple should also be contacting their State Senator and Assemblyman along with Nancy Pelosi.

I always enjoying seeing liberals reaction when they have to face reality. Don’t worry you aren’t being canceled just transitioned from your old skimpy policy. Your gov’t insurance will be so much better.

So the article talks about subsidies for those whom cannot afford the ACA as if it is the ignorance of these that makes the most problems.

The government will give some poor people money to pay for insurance, ah how fuzzy wuzzy and warm and tingly, what ever happened to people realizing that which is given by the government can be taken away by the same government? Now that is the up front and accosted method, but how about I introduce you to a whole new different way were this can happen.

First some history in 1913 the federal government through voting and legal procedures created the I.R.S. so that it could begin collecting taxes directly through the executive branch when it was passed the median income of the entire country did not have to worry about paying taxes, in fact there were entire states that did not have a single person paying the I.R.S. taxes. How did we go from that historical example to today where everyone whom makes any amount of income is responsible for paying into the I.R.S.? It is called inflation, the I.R.S. tables were not actuated to take into account inflation therefore the money has become so devalued today as compared to when the I.R.S. was created, that practically anyone receiving any amount of income is subject to the I.R.S. (notice I am not arguing any of this is good or bad, I am attempting to point out how the subsidies of the ACA can and will become null and void for everyone no matter how little their meager paychecks will purchase). The subsidies are not actuated to take into account the monetary inflationary practices of the U.S. Federal Reserve Bank over a long enough period of time due to the continued practice of Quantitative Easing by the central bank the subsidies will be unattainable. Whether it is an immediate con job or one that plays out on a longer time line does it really matter that this is destined to fail? This was not what was sold to the American People but continue to harbor your delusional thoughts that the Government can fix this!

This is what Obamacare is supposed to do. Incentivise people to lower their income so that they all qualify for subsidies and then make their hardworking neighbor pay for theirs. And that should give us a clue as to where Obamacare is headed to, if anyone remembers the death spiral warning.

And sure folks, don’t change your views because of this situation and that of 14 million others that lost their insurance for no fault of theirs even though they liked their policies and those policies were compliant with state health insurance requirements.

It is worrisome to even imagine that there are people like these that would follow their leader blindly wherever he leads. Leftism has become a religion for many.

The problem with liberalism is that there is no free lunch. Yet many liberals do not see the cost themselves since the easy way out is to tax the “rich” and “big businesses” more (for their “fair share”). What’s good about ACA is that these liberals now have to bear part of the cost of Obamacare. Yet the hypocrisy lives on—their solution is to earn less and get a subsidy. So it’s still a dependency mindset—get someone else to pay for their entitlement. The sad thing is that this couple do not seem to realize the flaw in their liberal beliefs.

It isn’t the premiums that are the real story. It is the “tax” in the form of the out of pocket expenses from deductibles and caps that will be the real silent financial killer to all these people. Potentially, these expenses could double a persons real premium obligations. The way to fix the health care system is simple. Prohibit the insurance companies from making money on premium investments and force them to profit only on the difference between premiums and what they pay out in claims. It will force the insurance companies to demand lower costs from providers across the board in the health system. Right now, there is zero incentive for the insurance companies to pursue lower costs because they make more money from investments which incentivises them to drive premiums and underlying health care costs higher.

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